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KMID : 0614620070490020106
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Korean Journal of Gastroenterology
2007 Volume.49 No. 2 p.106 ~ p.109
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A Case of Biliary Cast Syndrome after Cadaveric Liver Transplantation
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Seo Chang-Jin
Jung Jin-Tae
Han Ji-Min
Kim Ho-Gak
Lee Joo-Hyoung
Choi Woo-Young
Sung Sang-Hun
Choi Dong-Lak
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Abstract
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We experienced one fatal case of biliary cast syndrome after cadaveric liver transplantation involving both intrahepatic ducts. A 58-year-old man underwent cadaveric liver transplantation because of hepatitis B virus related liver cirrhosis and concomitant hepatocellular carcinoma. Five weeks after the liver transplantation, postoperative course was complicated by development of acute cholangitis. Subsequent endoscopic retrograde cholangiography revealed diffuse intrahepatic bile duct strictures without filling defects. Percutaneous liver biopsy, which was done to exclude rejection, revealed biliary cast. Successful endoscopic removal was precluded due to its diffuse involvement. Because of the deterioration of patient`s condition by refractory biliary obstruction and cholangitis, retransplantation from cadaveric donor was performed. Debridement of the biliary tree after graft removal yielded a near-complete cast of the intrahepatic ductal system. Biliary cast syndrome should be suspected when jaundice or cholangitis is associated with dilated ducts on abdominal imaging studies in cadaveric liver transplantation recipients. Initial therapeutic options include removal of biliary cast after endoscopic or per-cutaneous cholangiography. Although endoscopic retrieval of biliary cast by endoscopic retrograde cholangiopancreatography could be employed as a first-line management, other modalities such as endoscopic nasobiliary drainage, percutaneous transhepatic drainage, or retransplantation should be considered when complete removal is not feasible and the condition of the recipient deteriorates. (Korean J Gastroenterol 2007;49:106-109)
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KEYWORD
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Biliary cast syndrome, Biliary stricture, Cadaveric Liver transplantation
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